Healthcare Provider Details

I. General information

NPI: 1063792430
Provider Name (Legal Business Name): ALLIED PROFESSIONAL PARTNERS SLP & PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR SUITE LL 105/108
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

255 EXECUTIVE DR SUITE LL 105/108
PLAINVIEW NY
11803-1718
US

V. Phone/Fax

Practice location:
  • Phone: 516-827-7478
  • Fax: 516-908-4607
Mailing address:
  • Phone: 516-827-7478
  • Fax: 516-908-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number012962-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number005908-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003016-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003083-1
License Number StateNY

VIII. Authorized Official

Name: MR. ANDREW E VAUGHAN
Title or Position: OWNER
Credential: PHD
Phone: 516-458-8715